Trigger wrist: a case report

Previously published reports on trigger wrist have described triggering of the fingers at the wrist. We observed a case of true triggering of the wrist that was due to a nodule in the extensor carpi radialis longus tendon as it entered the second dorsal compartment. Reduction tenoplasty of the traumatic nodule and release of the second dorsal compartment relieved all symptoms. This is the first reported case that is accurately identified as trigger wrist.     

Chronic ulnar wrist pain secondary to partial rupture of the extensor carpi ulnaris tendon

An unusual case of symptomatic partial rupture of the extensor carpi ulnaris (ECU) tendon after trauma is described. The patient was successfully treated by surgical removal of a prominent ulnar ridge, debridement of the ECU tendon, and ECU subsheath reconstruction. Extensor carpi ulnaris subluxation and partial rupture should be considered in the differential diagnosis of a patient with chronic ulnar wrist pain.     

Autogenous graft repair using semitendinous tendon for a chronic multifocal rupture of the extensor hallucis longus tendon: a case report

Chronic multifocal closed rupture of the extensor hallucis longus tendon is an extremely rare injury. Previously, chronic multifocal partial rupture of the extensor hallucis longus tendon had not been reported. This case study reports one case of autogenous graft repair of a chronic multifocal rupture of the extensor hallucis longus tendon using a semitendinous tendon autograft.     

Ulnar-styloid nonunion and partial rupture of extensor carpi ulnaris tendon: two case reports and review of the literature

Two unusual cases of symptomatic partial rupture of the extensor carpi ulnaris tendon associated with ulnar-styloid nonunion are described. Intraoperative findings suggested that the jagged surface of the distal ulna was the cause of flaying. In one case, debridement of the frayed extensor carpi ulnaris tendon and fixation of the ulnar styloid were effective for the relief of symptoms. But after the same procedure in another case, osteosynthesis of the ulnar-styloid could not be attained and tenodesis of the extensor carpi ulnaris tendon to the ulnar head was needed. Partial rupture of the ECU tendon should be taken into account in the differential diagnosis of a patient with ulnar wrist pain after ulnar-styloid fracture.     

Late spontaneous rupture of extensor pollicis longus tendon after blunt trauma with no residual fracture

Spontaneous rupture of extensor pollicis longus tendon was first reported by Dupley in 1876. This rupture has been reported after distal radius fracture (Colles fracture), rheumatoid arthritis, steroid injections or systemic steroid treatment, and occupational tenosynovitis. The main etiologies of this rupture are the fracture of the tendon over the irregular bone surface following the fracture or inflammatory processes as in rheumatoid arthritis. Most ruptures are usually found at Lister’s tubercle. Some authors suggested ischemic etiology in the cases following wrist trauma with no residual fracture. We describe a case of rupture of the extensor pollicis longus tendon 1 month after a blunt wrist trauma with no residual fracture. The rupture was at the myotendinous junction (MTJ). To highlight on this rupture, we believed it was caused from both vascular and mechanical factors. The mechanical factor was the position of the myotendinous junction under the extensor retinaculum. The vascular factor was the nature of the myotendinous junction being the most sensitive to ischemia.Level of Evidence: Level V, diagnostic study.     

Trigger wrist caused by a partial laceration of the flexor superficialis tendon of the ring finger

Trigger wrist is a rare condition. This report describes a case with trigger wrist secondary to a partial laceration of the flexor digitorum superficialis tendon of the ring finger. No previous reports are available in the literature.     

Trigger wrist phenomenon in rheumatoid arthritis

Flexor tendon synovitis in patients with rheumatoid arthritis commonly presents with a carpal tunnel syndrome and a concomitant trigger finger. Triggering at the wrist joint is in this disease an uncommon additional feature. In the two cases reported, histological examination of the tissue has indicated that, as well as chronic synovitis, there was a true rheumatoid nodule present at the wrist joint, either pedunculated or fusiform. The passage of the nodule, with a 'Click' from the proximal side of the transverse carpal ligament to the distal aspect, when the fingers are flexed, creates the sensation, signs and symptoms of a trigger wrist.     

Trigger Wrist

Trigger wrist is a relatively rare disease compared to trigger finger, which is the most common disorder found in hands. Patients with trigger wrist usually complain about the following symptoms: snapping and clicking or triggering around carpal tunnel with or without mild to moderate median neuropathy. There are a total of five cases of trigger wrist: three cases of anomalous muscle belly of flexor digitorum superficialis and two cases of fibroma around flexor tendon sheath within carpal tunnel. This study reports on two of those cases: one with anomalous muscle and the other with fibroma of flexor tendon sheath. Accurate examination and proper diagnosis are mandatory to obviate improper and time-wasting treatment for patients with trigger wrist.     

腕背伸肌支持带筋膜瓣在桡骨远端骨折背侧入路中的应用

目的：探讨腕背伸肌支持带筋膜瓣在桡骨远端骨折背侧入路中的临床应用。方法选择2010年6月至2015年6月我院收治的桡骨远端骨折需行背侧入路固定病人120例。按照就诊的先后顺序采用数字表法将病人随机分为两组,筋膜瓣组52例病人骨折复位固定后采用腕背伸肌支持带筋膜瓣对拇长伸肌腱进行转位,常规手术组68例病人仅采用常规骨折复位固定手术。术后随访观察并比较两组病人拇长伸肌腱并发症的发生率。结果本组120例病人均手术成功,均获得随访,随访时间为3~60个月（平均为16.2个月）。筋膜瓣组未出现肌腱并发症;常规手术组发生3例拇长伸肌腱炎,1例拇长伸肌腱断裂,肌腱并发症发生率为5.88%。筋膜瓣组的肌腱并发症发生率明显低于常规手术组,差异有统计学意义（P=0.075）。结论与掌侧入路钢板置入治疗桡骨远端骨折相比,背侧入路钢板置入固定后的肌腱并发症发生率较高,腕背伸肌支持带筋膜瓣可以很好地避免这一并发症,并且操作简单,值得推广使用。     

Bilateral rupture of the extensor pollicis longus tendon. A case report

Bilateral rupture of the extensor pollicis longus (EPL) is a rare entity and the few cases that have been reported were associated with an underlying systemic condition such as rheumatoid arthritis or following an injury. We present the case of a patient who was referred to us with a spontaneous rupture of the EPL tendon of the right wrist and that of the left side observed 2 months after tenosynovectomy. The patient had not any pathologic condition or evidence of trauma in both wrists. In the left side, he was operated on and a tenolysis and subcutaneous tendon transposition was performed. Despite this preventive surgery, the patient suffered from a tendon rupture. The possible causes of surgery failure are discussed.     

Subcutaneous rupture of the flexor hallucis longus tendon: a case report

It is well known that rupture of the flexor hallucis longus tendon can be associated with open injuries and that closed rupture of the flexor hallucis longus tendon is rare. Tendon injuries of the foot can occur secondary to direct, indirect, or repetitive injury. Repetitive tendon injuries can cause tendinitis or stenosing tenosynovitis. Tendinitis is associated with internal tendon injury that can present with tendon thickening, mucinoid degeneration, nodule development, or in situ partial tears. Stenosing tenosynovitis is the development of tendon adhesions within the tendon sheath that interfere with tendon gliding, known as trigger toe. The flexor hallucis longus tendon is susceptible to injury along its entire course. A total of 35 cases of complete or partial closed ruptures of the flexor hallucis longus tendon have been reported. We present the case of complete subcutaneous rupture of the flexor hallucis longus tendon associated with trauma at the proximal phalangeal head.     

Snapping wrist caused by tenosynovitis of the extensor carpi radialis longus tendon subsequent to subcutaneous muscle rupture in the forearm: case report

We report a rare case of snapping in the dorsal wrist that was caused by extensor carpi radialis longus tenosynovitis occurring after rupture of the muscle in the middle forearm. After resection of the tendon at the wrist, the snapping disappeared.     

Wrist position and extensor tendon amplitude following repair.

After primary repair of severed extensor tendons, various methods are used to limit tendon adhesions and avoid rupture. Early passive digital motion with wrist extension (a "reverse Kleinert" protocol) has been advocated. However, there are no data to support an optimum wrist position or to indicate how much finger motion may safely be permitted. In this study we used eight fresh cadaver limbs to measure extensor tendon gliding in Verdan's zones 3 to 8 when active grip and passive extension were simulated at different wrist positions. We found that if the wrist is extended more than 21 degrees, the extensor tendon glides with little or no tension in zones 5 and 6 throughout full simulated grip to full passive extension, permitting "passive motion" exercises to minimize tendon adhesions without risking rupture. In addition, we found that up to 6.4 mm of tendon can be debrided safely and full grip can still be permitted postoperatively if the wrist is splinted at 45 degrees extension.     

Delayed rupture of the extensor pollicis longus tendon: a retrospective study

Eight patients with delayed rupture of the extensor pollicis longus tendon are presented. Six had suffered from a fracture of the wrist without dislocation. This is in our opinion a predisposing factor in the etiology of delayed tendon rupture. Our treatment of choice is transfer of the extensor indicis proprius tendon. In all patients satisfactory thumb function was restored.     

Bifocal disruption of the knee extensor apparatus (“floating patella”) in a 13-year-old patient

We present the unusual case of a traumatic “floating patella” in a 13-year-old healthy boy. No predisposing factors were diagnosed. The obvious bony avulsion was treated by immediate open reduction and screwing, whereas the quadriceps tendon rupture was missed diagnostically in the first step. During the course of the treatment, the extension lag lead to the delayed diagnosis of the concomitant rupture of the quadriceps tendon. After the surgical treatment of the latter, the patient healed with full function of the extensor apparatus and full ROM. Bifocal injury of the knee extensor apparatus is therefore possible in young adolescents without presenting the predisposing factors and should thus be considered.     

Hazards of steroid injection: Suppurative extensor tendon rupture

Local steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain''s tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.     

Correction to: A Clinical Approach to Diagnosing Trigger Wrist

BackgroundTrigger wrist is a relatively unusual condition, produced by wrist or finger motion. The various causes of trigger wrist can originate from flexor tendon, extensor tendon, bones, or tumour. A proper clinical approach is required to diagnose and manage patients with trigger wrist.MethodsA keyword search was performed across Google Scholar and PubMed. Articles describing trigger wrist conditions were analysed. Based on the information obtain from the articles, the clinical manifestations and approach to diagnosing the cause of trigger wrist is discussed.ResultsA detailed history alone may lead to a reasonably accurate diagnosis. Patients can present with trigger wrist occurring during movement of the fingers or with wrist movements. Presence of tenderness around A1 pulley suggest trigger finger. Absence of tenderness over the A1 pulley may suggest trigger wrist. The wrist should be examined for any swelling or malunion around the wrist joint. Palpate for any bony prominence, clicking, or crepitus with the movement of the wrist. Examination for the presence of carpal tunnel syndrome should be performed. A simple radiograph of the wrist joint is needed to see any possible bony pathology such as malunion, instability or arthritis of the carpal bone. For soft tissue assessment ultrasound would be a good choice and can be done during finger or wrist movement. MRI is useful for further assessment of space occupying lesion within the carpal tunnel and is useful for surgical planning. Nerve conduction study is indicated for patients with median nerve compression symptoms. During the initial stage, the patient should be advised for activity modification to reduce the wrist and finger movements. Surgical treatment will depend on the causative factor. Surgery done under local anaesthesia has the advantage of reconfirming with the patient, resolution of triggering during surgery by asking the patient to actively move the fingers or wrist. ConclusionsTrigger wrist is a relatively rare condition compared with trigger finger, which is the most common disorder of the hand. To avoid inadequate and ineffective treatment of patients with trigger wrist, careful examination and proper diagnosis are vital.     

Measurement of gliding resistance of the extensor pollicis longus and extensor digitorum communis II tendons within the extensor retinaculum

PURPOSE: The etiology of spontaneous extensor pollicis longus (EPL) tendon rupture is still largely unknown. It is possible that friction within the sheath may play a role. The purposes of this study were to compare gliding resistance of the EPL tendon with that of the extensor digitorum communis tendon of the index finger (EDC II) and to find the wrist position that gives the EPL tendon the lowest gliding resistance. METHODS: Fifteen fresh-frozen cadavers were used. Gliding resistance was measured directly in 7 different wrist positions. RESULTS: The mean gliding resistance of the EPL tendon was 0.16 +/- 0.08 N and that of the EDC II tendon was 0.11 +/- 0.06 N. This difference was significant. There was also a significant effect on gliding resistance due to wrist position. For the EPL tendon, the gliding resistance was significantly greater in 60 degrees wrist flexion compared with all other wrist positions tested. Additionally the gliding resistance of the EPL in 30 degrees flexion, 60 degrees extension, and 15 degrees radial deviation was significantly higher than wrist positions of 30 degrees extension, neutral, and 30 degrees ulnar deviation. CONCLUSIONS: Positioning the wrist close to neutral flexion/extension and in some ulnar deviation minimizes the friction within the EPL sheath. Such positions may be advantageous for splinting patients at risk for EPL rupture.     

Rupture of extensor tendon secondary to previously undiagnosed Kienböck disease

Abstract

We report three patients with an unusual pattern of rupture of the extensor tendon. All were found to have previously undiagnosed Kienböck disease. Radiographic study of the wrist is essential before treating any closed rupture of an extensor tendon. Lesions may be progressive and extend to adjacent tendons and should be treated urgently.     

Rupture of the extensor pollicis longus tendon without fracture after wrist trauma: case reports.

Four cases of rupture of the tendon of the extensor pollicis longus without detectable fracture after wrist injury are reported. The clinical features of this condition did not differ materially from those of rupture occurring after a Colles fracture. All patients were rather young, the average age being 40 years. In one patient rupture occurred a day after injury. In all patients satisfactory thumb function was restored with extensor indicis proprius tendon transfer.